Performance Excellence and Accountability in Kidney Care (PEAK) is a voluntary quality improvement campaign undertaken by Kidney Care Partners and the kidney community to reduce mortality among first-year dialysis patients on a national level.

The PEAK Campaign to reduce mortality in the first year will focus on increasing the importance of patient education and key clinical care activities to achieve its goal.

Who are ESRD patients?
Patients on dialysis are your family members, friends, and colleagues. Irreversible kidney failure affects 400,000 Americans and the number grows each year at an increasing rate. Kidney failure is fatal unless a patient receives one of two types of treatment – dialysis or kidney transplantation. The shortage of donor organs limits transplantation, so the vast majority of patients undergo regular dialysis treatments of three to four hours duration, three times a week. Today’s patients are older and sicker than those first enrolled in the Medicare ESRD program, due primarily to the aging of the population and the long-term effects of diabetes and hypertension, the leading risk factors for chronic kidney disease, the precursor to kidney failure.

African Americans, Hispanics and other minority groups are most at-risk for developing kidney failure. And while African Americans make up just 12 percent of the general population, they account for 30 percent of people with kidney failure.

Why focus on mortality in the first year of dialysis?
Within the ESRD community, there is increasing recognition of the significant mortality rate that is associated with initiation of chronic dialysis.

Consistently over the past ten years, end-stage renal disease (ESRD) survival rates have improved; however, first-year mortality has remained stable compared to overall mortality. In fact, recent data from the 2008 US Renal Data System (USRDS) report highlights the persistent high mortality rate in ESRD patients in the first year of their life on dialysis– an annualized rate of about 30 percent. This is in contrast to the improvement seen in the mortality of dialysis patients between 2-5 years after dialysis initiation. The kidney care community recognizes the need to improve the first-year mortality rate as compared to other industrialized nations.

Studies on how to reduce the high morbidity and mortality in the first year on dialysis have been few and infrequent. Recent work, however, has documented that a broad range of interventions early in the patient’s life on dialysis can significantly improve survival. For example, there is the type of access (catheter, graft, and fistula) with which the patient initiates dialysis combined with case management can have a strong influence on subsequent outcomes.

Why PEAK?In 2009, the kidney care community launched PEAK and committed to the first area of emphasis for the campaign – reducing mortality in first-year dialysis patients by 20 percent by the end of 2012 and extending an estimated 10,000 lives – a real goal to save lives.

Under PEAK, KCP is partnering with a multidisciplinary team that has experience in the measurement of health care provider quality performance, generally, and ESRD and chronic kidney disease, specifically. The team brings a unique combination of skills and highly relevant experience, consisting of:

Physicians and researchers highly experienced in quality measurement and improvement at Quality Partners of Rhode Island (QP), the State’s Quality Improvement Organization (QIO), which has a long standing relationship with Brown Medical School and the Center for Gerontology.

Led by Kidney Care Partners, with support from its research partners as well as experts in the kidney care community, the PEAK Campaign will:

The PEAK Campaign to reduce mortality in the first year will focus on patient education and
key clinical care activities to achieve its goal. Research has shown that a broad range of
interventions early in a patient’s life on dialysis can have a strong influence on patient
outcomes and successfully reduce mortality, including case management, nutrition, anemia management,
dialysis adequacy, catheter use, and psychological and social support.

Background
In 1972, Congress committed to provide Americans who have kidney failure with coverage for their lifesaving therapy through the Medicare program. Medicare's End Stage Renal Disease (ESRD) program continues to play a vital role in ensuring access to high quality, lifesaving therapy for patients with kidney failure. Better care for patients leads to better quality of life, improved rehabilitation, fewer medications, and fewer hospitalizations.

A History of Quality ImprovementQuality of care for patients with ESRD is an important issue not only for patients and providers, but also for policymakers. As lawmakers consider national health care reform, quality is unarguably a top priority. The kidney care community has shown a proactive commitment and leadership in efforts to continuously improve the care provided dialysis patients.

In 2005, Kidney Care Partners launched the Kidney Care Quality Alliance (KCQA), adopting a forward-looking approach to the quality of kidney care by addressing performance measurement, public reporting and pay-for-performance reporting. Since that time, KCP and KCQA have worked closely with the National Quality Forum (NQF), submitting proposed measures for quality improvement for consideration, of which five received time-limited endorsement; pilot testing of these measures is currently underway. Additionally, the specifications for several more KCQA measures were aligned with CMS measures and also were endorsed by NQF.

Notwithstanding KCP’s and the kidney care community’s significant accomplishments, quality improvement is not a static process. Thus, just as it was forward-looking in the area of performance measurement, in 2008 the kidney care community began to explore the launch of a National Quality Goals Initiative focused on community-wide quality improvement – with the resultant PEAK Campaign.